UR Ventures

• Performs complex secretarial and administrative duties in a fast-paced environment supporting clinical, educational, and academic programs. • Responsible for all clinic preparations, including but not limited to providers' time and calendar management while optimizing provider-patient schedule, coordination of patient care, and information/data support. • Serves as primary contact for provider(s). • Manages provider(s) calendar and prioritizes appointments and meetings based on provider preferences. • Chooses and recommends among competing demands. • Examines the clinical schedule(s) on a continuous basis to identify opportunities for optimizing the time and effort of providers. • Finds missing orders and sends them for review and approval. • Anticipates needs of insurance companies by gathering all necessary information for referrals and prior authorizations. • Applies provider preferences and protocols in selecting multiple possibilities to execute and/or delegate follow-up actions based on the provider’s patient notes. • Composes, edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims, including compiling all necessary information and drafts for provider signature. • Manages provider(s) documentation and information. • Composes and types non-routine correspondence providing factual information. • Arranges travel, conference registration, and hotel accommodations. • Interfaces with organizations, hospitals, and others to facilitate invited lectures and speaking engagements for the provider. • Researches hospital medical records for the information requested by physicians, insurance companies, and attorneys. • Determines the order of daily surgeries and ambulatory procedures based on the patient’s medical conditions and severity. • Negotiates surgical/procedure schedule by communicating complex details directly to the Operating Room scheduling office and Ambulatory Surgical Center Staff. • Authorizes overbooking and rearranging of surgeon's Operating Room schedules based on case complexity and medical urgency. • Authorizes rescheduling when cancellations occur by applying protocols for surgical scheduling. • Orders all necessary surgical/procedure equipment, devices, and medication based on the application of protocols needed to conduct the surgery/procedure. • Follows-up to confirm the order is fulfilled and ready for surgery/procedure. • Employs multiple contingency strategies to ensure all details, materials, and locations are ready for surgery/procedures as scheduled. • Ensures patient education and follow-up details vary according to pre-operative readiness and post-operative rehabilitation expectations and activities. • Accountable for completeness of all relevant information from pre-op testing and evaluations for review by the anesthesiologist and the Operating Room. • Assembles the necessary details from multiple tabs within the electronic medical record for review and inclusion when completing disability paperwork. • Assesses calls to understand patient needs, prioritizes medical concerns, and obtains responses from providers and follows up with patients. • Serves as main point of contact for patients pre and post-operative. • Other duties as assigned.

Title: Clm Resltion Rep III, Hosp/Prv Location: Rochester Technology Park Job Description: As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. Job Location (Full Address): Remote Work - New York, Albany, New York, United States of America, 12224 Opening: Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910402 United Business Office Work Shift: UR - Day (United States of America) Range: UR URCA 205 H Compensation Range: $20.30 - $27.41 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations. Responsibilities: GENERAL PURPOSE The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management. ESSENTIAL FUNCTIONS With general direction of the Manager/Supervisor/Lead: 40% Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. 25% Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. - Research claims, identify problems, and take appropriate action to assure claim resolution. 20% Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. - Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. - Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. - Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. 10% Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. - Escalates system issues preventing claims submission and follow-up for review and resolution. 5% Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate. May perform other duties as assigned. QUALIFICATIONS Required: - Associate degree and 2 years of related relevant experience; or equivalent combination of education and/or experience - Excellent problem-solving skills - Excellent communication skills - Excellent customer service skills Preferred: - Strong working knowledge of the professional billing software applications - Ability to type 25 wpm. The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

Title: Clm Resltion Rep III, Hosp/Prv remote type Hybrid locations Rochester - NY Rochester Technology Park time type Full time job requisition id R267020 Job Description: As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive. Job Location (Full Address): Remote Work - New York, Albany, New York, United States of America, 12224 Opening: Worker Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 910402 United Business Office Work Shift: UR - Day (United States of America) Range: UR URCA 205 H Compensation Range: $20.30 - $27.41 The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations. Responsibilities: GENERAL PURPOSE The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management. ESSENTIAL FUNCTIONS With general direction of the Manager/Supervisor/Lead: - 40% Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services. - 25% Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and takes appropriate action to assure claim resolution. - 20% Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. - 10% Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. - 5% Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate. May perform other duties as assigned. QUALIFICATIONS Required: - Associate degree and 2 years of related relevant experience; or equivalent combination of education and/or experience - Excellent problem-solving skills - Excellent communication skills - Excellent customer service skills Preferred: - Strong working knowledge of the professional billing software applications - Ability to type 25 wpm. The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

• Recommends, plans, evaluates and translates clinical practice, operations, policy and procedures into electronic content and workflows. • Configures the electronic health record system to improve operations, standardize processes, gain workflow efficiencies and improve patient care. • Performs in-depth analysis and facilitates development of integrated workflows. • Completes the functional design and build of the eRecord system with minimal guidance. • Collaborates with others and uses critical thinking to seek resolution of system issues or conflicts for points of integration and communicates risk implications to team lead/project manager. • Reviews requested enhancements. • Prioritizes and implements requested changes to the system. • Works with the project team, subject matter experts, training, and technical team to define processes that cross applications and functional areas. • Participates in the upgrade process. • Acts as representative for the team as needed and attends upgrade meetings. • Coordinates the activities of application-level team. • Builds reports and workflows and tests work of self and others as needed. • Identifies and resolves complex issues. • Maintains standards for system build, including following naming and numbering conventions, security classifications, database/spreadsheets for system build, and change control. • Adheres to organizational policies and procedures. • Builds relationships and effectively communicates with the project team, key stakeholders, and physician practices as required. • Performs tasks that maintain the foundational components and/or performance of the eRecord system with limited guidance.

• The Application Administrator builds, maintains, monitors and audits on-premise application installations. • Ensuring security standards are applied, troubleshooting, implementing new solutions, and participating in projects to upgrade components or whole systems. • Provides technical support for non-production and production environments, including troubleshooting and remediation of technical issues. • Researches and answers technical application, database, server, and security configuration questions and provide on-call support after hours as defined by the application support requirements. • Monitors non-production and production environments and works in conjunction with database administrators, security, and systems administrators to provide performance tuning on application, database, server, and security settings and features. • Applies patches and delivers minor and major application upgrades. • Participates in regular team retrospective events with a continuous improvement mindset. • Updates application administration documentation and procedures for maintaining applications, databases, servers, and security.

• Minimizes reimbursement barriers for patients and providers by assisting with determining coverage and access options • May assist healthcare providers with questions related to payer policies, patient assistance, and reimbursement support services • Resolves coverage and reimbursement issues that may create barriers to access for patients • Remains knowledgeable of private payer, Medicare, and Medicaid structure systems and reimbursement processes • Respond to all patient, nursing, and provider account inquiries • Determines practitioner eligibility for enrollment • Completes and processes all paper and/or electronic applications for the government payers and non-delegated commercial payers • Completes applications to revalidate individual providers, as well as University of Rochester groups, with Medicare and Medicaid as required each cycle • Completes new enrollments of APP’s and performs updates regarding changes for enrolled APPs for the commercial delegated payers such as change in locations, tax IDs, etc. • Ensures applications and files are securely submitted to the respective entities upon completion and in accordance with the specific requirements • Communicates status of files or other payer enrollment/credentialing information directly to providers, various department representatives, and/or outside organizations, clients or affiliates • Coordinates activities related to the electronic submission of applications through the online Medicare system as well as paper applications • Analyzes application and supporting documents for accurateness and completeness, including all required verifications and documentation • Sets up new University groups with new Tax IDs with the appropriate government payers as needed • Works with team leaders and staff to ensure files and/or applications and revalidations are completed accurately and within the required timeframes • Documents and tracks the status of provider enrollment applications for Medicaid, Medicare, and some Commercial Payers that are not part of Delegation • Tracks and maintains individual provider specific information in database for the APPs for commercial delegated payers for monthly submission • Completes the Electronic Provider Assisted Claim Entry System enrollment for electronic Medicaid billing for new provider after they are approved by Medicaid, when applicable • Sets up the Electronic Transmitter Identification Number (ETIN) for electronic Medicaid billing for individual and group enrollments, when applicable • Coordinates the transfer of data and electronic information with key leaders, including the hospital electronic medical record team and the delegated commercial payer with contracts • Collaborates directly with providers and various department representatives, including billing, to obtain information related to practice addresses, taxonomy codes, and to secure provider and authorized official signatures • Communicates the status of the applicants credentialing and payer enrollment files directly to providers and various department representatives and coordinates efforts to obtain necessary information and/or documentation to ensure deadlines are met • Notifies providers and various department representatives when approval and enrollment confirmation is received from the payers • Assists APPs as requested with the CAQH (Committee for Affordable Quality Healthcare) profiles • Collaborates with other University departments to ensure compliance with all standards and policies • Responds to inquiries from other healthcare organizations and interfaces with internal and external customers on day-to-day payer enrollment issues as they arise • Represents the department for various initiatives and/or committee meetings as needed • Serves as the primary back up to all payer enrollment staff and management • Serves as a Team Peer Interviewer as needed • Other duties as assigned

• Recommends, plans, evaluates and translates clinical practice into electronic content and workflows • Configures the electronic health record system to improve operations • Assists with leading tasks, ensuring timelines are met • Collaborates with the project team and key stakeholders • Plans, analyzes, designs, implements, tests, debugs and maintains EHR software applications • Identifies barriers to project completion and communicates needs • Participates in the upgrade process and ensures necessary build and testing

• Manages and administers on-premise and cloud-based infrastructure services • Develops scripts and code to deliver solutions • Leads the design, setup and maintenance of a continuous infrastructure integration stack • Oversees, orchestrates and automates deployment of solutions hosted on both cloud services and on-premise infrastructure

• Prepares instruments, equipment and supplies adhering to principles of sterile techniques utilizing technical knowledge • Responsible for proper care and handling of instruments • Assists the clinical staff by performing assistive/advocacy services in caring for the patient • Follows policies, protocols, techniques and manufacturer’s guidelines when reprocessing and assembling and maintaining specialized instruments and equipment utilized in the operating room and patient care area • Documents required information and maintains records for instruments and equipment • Undertakes continuous education and trains in all areas of sterile processing

• Reviews system edits and assigns appropriate codes from appropriate coding classification system to ensure the production of quality healthcare data and accurate professional payment • Prepares reports for designated leader(s) • Uses knowledge of coding systems and system logic to review codes created by electronic charge capture and/or assign appropriate codes through medical record documentation as per designated workflow • Completes system edit reviews to make corrections before transmittal • Ensures work queue and responsibilities are handled within established guidelines and timeframes • Troubleshoots problems that prevent claims from being released • Identifies cause of edit and independently resolves issue by reviewing the patient encounter to understand the nature of the problem • Consults with internal customers and external vendors to obtain greater specificity and/or clarification when documentation appears inconsistent or incomplete • Prepares reports for designated leader to document recurring problems and identifies the source of reimbursement delays • Works closely with designated leader to ensure effective communication to resolve invoice payment delays • As necessary, provides Providers and other staff with information relative to coding • Responds to coding information requests and inquiries from various sources • Other duties as assigned